DATE (MM/DD/YY)
CERTIFICATE OF INSURANCE
Today's Date
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHT UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PRODUCER
INSURANCE AGENT OR BROKER
COMPANIES AFFORDING COVERAGE
COMPANY
A
INSURED
COMPANY
VENDOR'S NAME
COMPANY
INSURANCE COMPANY
B
C
COMPANY
D
COVERAGES
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO
LTR
POLICY EFFECTIVE POLICY EXPIRATION
TYPE OF INSURANCE
POLICY NUMBER
DATE (MM/DD/YY)
DATE (MM/DD/YY)
GENERAL LIABILITY
X
XXXXXX
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE
X
1/1/2009
12/31/2010
OCCUR
POLICY
PROJECT
ANY AUTO
XXXXXX
1/1/2009
12/31/2010
MED EXP(Any one person)
$
$
$
$
$
1,000,000
1,000,000
1,000,000
1,000,000
5,000
COMBINED SINGLE LIMIT
$
1,000,000
$
$
$
500,000
500,000
500,000
(EA ACCIDENT)
ALL OWNED AUTOS
BODILY INJURY
SCHEDULED AUTOS
(Per Person)
HIRED AUTOS
X
X
PRODUCTS-COMP/OP AGG
FIRE DAMAGE(Any one fire)
LOC
AUTOMOBILE LIABILITY
X
X
x
1,000,000
GENERAL AGGREAGATE
GEN'L AGGREGATE LIMIT APPLIES PER:
x
$
PERSONAL & ADV INJURY
CONTRACTUAL LIABILITY
X
LIMITS
EACH OCCURRENCE
BODILY INJURY
NON-OWNED AUTOS
(Per Accident)
PROPERTY DAMAGE
GARAGE LIABILITY
AUTO ONLY-EA ACCIDENT
ANY AUTO
OTHER THAN AUTO ONLY:
EACH ACCIDENT
AGGREGATE
EXCESS LIABILITY
EACH OCCURRENCE
UMBRELLA
AGGREGATE
OTHER THAN UMBRELLA FORM
X
WORKERS COMPENSATION AND
XXXXXX
1/1/2009
12/31/2010
EMPLOYERS' LIABILITY
WC STATUTORY
OTHER
LIMITS
ANY PROPRIETOR/PARTNER/EXECUTIVE
EACH ACCIDENT
OFFICER/MEMBER EXCLUDED?
DISEASE-POLICY LIMIT
IF YES, DESCRIBE UNDER SPECIAL PROVISION
DISEASE-EACH EMPLOYEE
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
DART, The City of Dallas, their directors, officers, representatives, agents, employees and all affiliated companies and organizations are listed as
additional insureds on the General Liability and Automobile Liability policies. A waiver of subrogation in favor of DART and the City of Dallas is
included as respects workers compensation.
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Dallas Area Rapid Transit
P.O. Box 660163
Dallas, TX 75266-0163
ACORD 25
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
© ACORD CORPORATION